0107-329 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cha�ter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class_, Exp. Date
C Illy 3
Signature of Contract
Date
"Al If -
OWNER -BUILDER DECLA, RATION
I hereby affirm under penalty of pt�rjury that I am' exempt from the Contractor's
License Law for the following reason:
( ) 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
I am..exempt under Section —, B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaiiy of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
RMONT RAWWRI WaN 30120-5
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensati34 provisions of Section 3700 of the Labor
Code, 1,shall forthwith comply witl� those p(ovisions.
Date- t Applicant -
Warning: Failure to secure Worker i orppensation coverage is unlawful and
shall subjectan employerto criminal penalties and civil fines upto $100,000, in
addition to the cost of compensatio damages as provided for in Section 3706
of the Labor Code, interest and a orney's fees.
IMPORTANT Application is hereby made to the Director of Building and S - a ' fety
for a permit subject to the conditions and restrictions set forth �on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize rep reset i tatives of this City to enter upon
the above-mentioned propert�ior inspection purposes.
i : 'I 1 '11 /1.(
Signature (Owner/Agent) \ "I � 11 1 Date'—'
Y-1 i
BUILDING PERMIT PERMIT #
DATE VALUATION LOT ZRACT
JOB SITE
ADDRESS 7-9-234 MMAUX. POINT
OWNER
CONTRACTOP EER
LUr.
TWEERIANSWORIH 1>0fXL C"ONTCRU M310
RO. BOX 342
14 85 GNMAOXY, #3
PALMDEIMV�r CA64 92261
PAW DIWIMM" CA 92211
(715�)564-4993 CHU 5115
USE OF PERMIT
P00J, ANDAVIVIVA
SPA 014LY. M.ARMS/8ARRIERS SIHAU. BE rN PLACE AT PREPIASTER
145PEC11014, POOL EQUIPMWT EXCIA)SURE NOT INMUDE D.
POOL ANWOR SPA 1000109 Ls
118 11MV11,193) C001 OF CONSMUCIYON
py"IT FEE SUMUNRY
PLAN CRECK RIM 1101 -.000-439-33 6 M05
1r0WSTXUCTIO14 YN 101 -000-418-W0 $111.00
'M WHANICAL YKE, - POOL 101 -OW -421-000 $24.00
RLWVP ICAL ITEE - POOL 101 -000-420-000 $45.00
P111JUBT140 FEE -- 11001, 101 -000-419-000 Q7100
: ;% 'Su. X, Cj)�p muemow Awn, puw cimcx
12-:31S 11RE-PAIDEMI
$269.0
510.00
AUG 1 2001 J1W, �LXMRNYTM s DUY B Ovy
-
L -------------------J
CITY OF LA QUINTA
RECEIPT
DATE,,/
1BY
D7 N?D
INSP��
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
I DATETINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I I
Final I I
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
V/
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
LT Voltage Wiring
Fixtures
Main Service
Si,!b Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
JUL-31-2001 14:08 tRADIT10.1� b0LF.`-tLUf"`!"' ?60 564 2356 P.01/01
d if hp 6 n
ARCHITECTURAL DESIGN REVIEW
July 31) 2001 Via Facsimile
760-777-7011
Ms. Nickie Gormley
Building and.Safety'
CM OF LA.QUINTA
78-495 Calle'Tampico
]La-'Quinta, CA 92253 -
Re: VaditbrL
is
0 e
1d'.Ca1if6rntaV,_1 ag Swimmi 'POO
Dear Nickie,
.This letter will serve as ADRCt roval to obtain a.�uil it for the swimming P0015
app, ding. Perm
qu6stions, plea�se do not hesitate
at the old California Village at Tradtioh.' if yoAi have any
to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
Aid......
cc: Jody Jones, APC (viafimc c4us mail)
78505 OLD AVENU 52 — L.AQurNTA -CA 92253,1126 PHoNE 760/564-3355 — FAx 760/564-2356
TOTAL P;01
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